This is not to say that the committee believes pain management services should be the sole responsibility of any one public health entity or of public health personnel. Instead, the committee acknowledges the understanding promulgated in The Future of the Public’s Health in the 21st Century that a contemporary public health system calls for “the contributions of other sectors of society that have enormous power to influence health” (IOM, 2002a, p. 2). With respect to improving pain management, those sectors include

  • the health care delivery system, for pain prevention, assessment, treatment, and follow-up;
  • health professions educational institutions, for improvements in education, mentoring, and modeling of good pain care;
  • businesses and employers, which influence group health insurance coverage policies;
  • the research establishment, for stimulating new understandings of pain that may lead to prevention, early intervention, and new treatments that are more effective and less problematic;
  • state and federal policy makers, who must craft policies related to patient safety, dispensing of opioid drugs, regulation of clinicians’ scope of practice, workers’ compensation programs, drug marketing, insurance coverage of pain services, and many others;
  • voluntary health organizations, especially those consumer-oriented groups devoted to pain conditions, but also groups for which pain is a significant problem for their primary constituents, such as the American Cancer Society, the American Diabetes Association, the National Alliance on Mental Illness, and many others;
  • the pharmaceutical and device industries, as they attempt to develop new, more effective, and more targeted analgesics;
  • accrediting and licensing bodies, which set the educational and practice standards for clinicians; and
  • the news and information media, which can affect public opinion and increase understanding of acute and chronic pain.

The variety of entities potentially involved in a broad-based effort to improve pain prevention and management across U.S. society offers promising opportunities for the kinds of public–private partnerships envisioned in the charge to this committee (see Chapter 1).

Recently released goals and objectives for Healthy People 2020—“the health agenda for the nation,” issued by HHS—appear to anticipate a larger public health role in pain management. Under the Medical Product Safety topic is a new objective—“Increase the safe and effective treatment of pain”—although this objective does not explicitly frame a comprehensive or strategic approach to pain, and three of its four subparts remain under development (Box 2-1).

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